HomeMy Public PortalAbout10539 LYNROSE ST_Electrical__ 1AB68•CEHDB10_60 APPLICATIO FOR ELECT ICAL PERMIT .
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 10539 L=ose St.
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY Temple.-City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Tract 2655.i� LOt
PERMIT FEES OWNER Thunderbird Estates .
ITEM NUMBER1 EACH I FEE MAIL -
OUTLET s g / $ $ ADDRESS
LIGHTS RECEPT W. (� .10 CITY TEL•. NO.
LIGHTIN&FIXTURES ,1O ! (�
ELEC.RANGES CLO.DRYERS ELECTRIdIAN T
W A T E R HEATERS .50 ADDRESS 2.610 So.
,,Peck -Road
�"1,
ELEC.SPACE HTRS. DISHWASHERS CITY Monrov EL NO. Hi 6-2131
GARBAGE DISPOSERS AUTO.. / STATE
WASHERS STA.COOKING UNITS ,25 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT O. GRO P NE P 11L -ESSED BY
O— 1& .25
VY— 2 .50. INSPECTION RECORD
2— 5 1.00
O
1.50 v
In— so 2.50 0
SO— 200 5.00
m
SIGNS: NO TRANS. U)
NO.LAMPS /Z
SERVICE 0-60OV 1.00
SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00 00
FIXTUREPERMIT 1.00 EI�
SUPPLEMENTARY PERMIT .50
TOTAL FEE S
—1—HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND8'1 TB THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 1 AA
WITH ASDL. COUNTY ORDINANCES AND STATE LAWS REGULATING J' /�)/dry
ELECTRICL WIRING. WIRING A//7 OCA L i�
1 'HERE Y CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSE REQUIRED BY LOS G COUNTY AND STATE OFTORE$
CALIFORNIA OR TH 1 A OWNER OF THE ABOVE `v .+ p•'
DESCRIBED RESIDE L P E POWER
SIGNATURE UTILITY CO.NOTIFIED i �• /
OF FERMI TTE FINAL �► �rjle� �� ..� *
LIDATIONARTHOR C.VF
cK NO CASH SUPERVISING.ELECTRICAL ENGINEER
LN;,'j3 9 60 1 E.- 'qAR 14 2 D 116 5�/
WORKERS'COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT L t
*1hereby:affirm that I have a certificate of consent to self � CE�troaG
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES i DEPT. OF PUBLIC WORKS LI
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
ElCertified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITYeZeXe
tion department. Multi-family Sq. Ft. NEAREST
Residential Swimming Pools I NROSS ST.
Date Applicant— Residential
y
AM
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ ANLAIL
DDRESS l
COMPENSATION INSURANCE First 20
2*0
(This section need not be completed If the work involved by CITY Tel. N
the permit is for one hundred dollars($100)or less.) Total No. Additional �Y�
that in the performance of the work for which this PLAN CHECK
I certify p APPLICANT
permit is issued, I shall not employ any person in any ma er Lighting Fixtures First 20 ADDRESS
so as to bec me subject to the Workers' m soli S. g g
> Additional
OW Date WMApplicant Total No. CITY Tel. No.
NOTICE TO APPLICANT: If, after making this ertiicate Fixed Appliances Not Over i HP
Exemption, you should become subject to the Workers' Range— Heater—D.W. — N r
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY „� Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCE 6D BY d
and Professions Code,and my license is in full force and effect. ���
Size&Type HP, KW, KVA, or KVAR O
License Number � 7 Lic. Cjassee--d Up to 1 Incl. FINAL U
r� 7 .� i Over 1 to 10 Incl. DATv�4IDATION 4 �O
Contract o Over 10 to 50 Incl. U
❑ FINAL �f
I am exempt under Sec. Over 50 to 100 Inc. BY / W
B.&P.C. for this reason Over 100 / d
Date: Services, Swbd., MCC&Panelboards �j ► i 9 or, Q 1 F Z
0-200 Amp. Under 600 V 30AV (/
Signature 201 - 1000 Amp. Under 600 V # 0 0 0 0 0
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 0 0 3 2:5 G
SINGLE FAMILY Tem Power Pole&Appurtenances o 0 0
HOME OWNER-BUILDER DECLARATION p' Ci 3 2 5 G
1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Q 6 L 7" 8
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Poo.
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE
Lender's Address TOTAL FEE
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby au horize repre tatives of this County to enter upon
the I o entio d perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Afv
Signal re of ittee Date